A case of thrombotic thrombocytopenic purpura following allogeneic bone marrow transplantation.
A case of thrombotic thrombocytopenic purpura (TTP) is reported in a 40-year-old man 6 months after allogeneic bone marrow transplantation for multiple myeloma. The features of TTP included microangiopathic haemolytic anaemia, severe thrombocytopenia, fluctuating neurological abnormalities, and progressive renal impairment. Despite treatment with anti-platelet agents, prostacyclin infusion, intensive immunosuppression and prolonged plasma exchange, the patient developed end-stage renal failure and is now on maintenance haemodialysis 18 months after the onset of TTP. Graft-versus-host disease and cytomegalovirus infection could not be implicated as aetiological factors, and cyclosporin medication had ceased 1 week before the clinical onset of his disease. The unusually intensive pre-transplant chemotherapy and radiotherapy protocol used in this patient appear to be most likely cause of the generalized endothelial damage resulting in TTP in this patient.
Tschuchnigg
M
M
Department of Haematology, Westmead Hospital, New South Wales, Australia.
Bradstock
K F
KF
Koutts
J
J
Stewart
J
J
Enno
A
A
Seldon
M
M
D000328:Adult; D016026:Bone Marrow Transplantation / Q000009:adverse effects*; D006801:Humans; D007676:Kidney Failure, Chronic / Q000209:etiology; D008297:Male; D009101:Multiple Myeloma / Q000601:surgery; D011697:Purpura, Thrombotic Thrombocytopenic / Q000209:etiology*; D014184:Transplantation, Homologous